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Intrauterine (coil) contraception self assessment

Intrauterine (Coil) Contraception Self-Assessment – Westgate
Required fields are labelled
What is your name?
What is your date of birth?
For example, 31 3 1980
What is your sex?
As recorded on your medical record
The one used to register with your GP
Anyone else with access to your email account may see responses sent to you

Assessment

It is important that you are suitably informed prior to the fitting of your intrauterine device (IUD) or intrauterine system (IUS). Please confirm the following:
I have read the information on intrauterine contraception provided Required
I understand that no method is 100% effective and that there is a small risk of failure (less than 1 in 100 chance of pregnancy; 1 in 2000 chance of having an ectopic pregnancy) Required
I understand that there is a small risk of pelvic infection (less than 1 in 100) in the first few weeks after insertion of the device Required
I understand there is a 1 in 20 chance of the device being expelled / falling out and that this may go un-noticed Required
I understand that there is a risk perforation of the womb at the time of insertion of the device and if this happens I may require an operation in hospital to remove the device. Required
I understand that the risk of perforation for most women is approximately 1 in 1000, this risk is higher if within 9 months of having a baby or during breastfeeding. Required
I understand that if breastfeeding the risk of perforation increases to approximately 6 in 1000 Required

Coil

Coil Type Required

Confirmation

I understand that it is not safe to insert an IUD/IUS if there is a risk of pregnancy Required
I am not at risk of pregnancy because: Required
E.g. Monday AM/PM, Tuesday AM/PM
Confirmation